Article

Identifying risk factors for severity & activity of Graves Orbitopathy - a multi-centre analysis of the characteristics and treatment of patients with Thyroid Eye Disease

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Abstract

Purpose Early diagnosis and treatment of Graves Orbitopathy (GO) is essential to prevent sight‐threatening complications and long‐term disability and therefore establishing a standard of care is highly desirable. Establishing predictors of a severe disease course are also vital to allow for early intervention. Methods A retrospective patient‐cohort study of 236 patients referred to three GO multidisciplinary (MDT) clinics between 2012–2019. Derived from this cohort, audit standards were compared against TEAMeD‐5 guidelines, looking in particular at; (i) time between referral and specialist review (ii) offering of smoking cessation and selenium supplementation where appropriate (iii) time from referral to treatment for moderate‐severe active disease. Patient characteristics were also analysed to investigate for any groupwise differences and correlations between variables collected at baseline to help predict subsequent disease activity. Results Median patient age was 48.0 years, 77.5% female, 30.1% White Caucasian. Median initial clinical activity score (CAS) was 1 (range 0–7). Additionally, 80.5% had positive TSH antibody titre. The median time between referral and first MDT clinic was 50.0 days. Of the 254 patients, 80/236 received IVMP for active moderate‐severe GO and the mean time to treatment was 9.3 days. All patients with sight‐threatening GO were seen and treated within 2 weeks. There were 52/236 (22.0%) current smokers, all of whom received documented smoking cessation advice. A positive correlation was found between TSH antibody titre (R = −0.2902, p = 0.0545). Conclusion The increasing recognition that an MDT approach is optimal for the management of GO requires a strong clinical governance framework. This work will further define the TEAMeD guidelines before the national implementation. Novel findings relating to the association of disease activtiy with biomarkers of diabetes and antibody titres are worth further investigation.

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